Articles Nurses may Never read…

The Journal of Experimental Psychology: Applied just released a special issue on “Cognitive Factors in Healthcare.”In the introductory article Morrow and Durso (2011) report that while progress has been made in the human factors front related to patient safety, problems are likely to increase in the future due to: the aging of society, The Affordable care act which will put more patients into the system, and the adoption of technology that can assist safety but often increases the complexity of providing care especially when it is not consistent with clinician needs, goals and practices. One of the challenges to research in the healthcare safety arena is the inability to manipulate variables when there can be such real consequences (Morrow & Durso, 2011). Theories applicable to aviation which is more structured and engineered don’t always translate well into healthcare which is considered to be more of a socio-natural system (Morrow & Durso, 2011). My full review continues here…

The articles in this special issue are phenomenal, sampling everything from minimally invasive surgery, and team mental models in anesthesia, to communicating the risks of STDs to young adults. All are well-worth purchasing however there are two nursing specific studies that are especially valuable. One involved scrub nurses’ attention strategies related to sponge count then stratified by experience versus novice nurses. The authors (Koh, et al., 2011) found that experienced nurses performed the count with significantly greater speed without loss of accuracy. This seemed to be related to their ability to stay on task by disallowing low priority interruptions. In fact the experienced nurses were much more focused on the incision area throughout the case than were the novice nurses who were much more susceptible to minor interruptions (Koh, et al., 2011).
The second article involves nurses’ visual scanning patterns in relation to identifying patients. Marquand et al., (2011) looked at the cognitive process of visual scanning patterns to see how nurses identified patient ID errors. In this study some ID bands were deliberately changed to have erroneous information and the nurses wore eye tracking devices to determine what they were looking during the various steps in the process. Not all nurses picked up the errors but those who did used the pattern of looking from the ID band to the chart: then the chart back to the ID band: then from the medication label back to the patient chart. The error was picked up only 61% of the time. Nurses who did not catch the ID band errors used a more random pattern of comparison. Marquand, et al., (2011) make some recommendations based on the results of this study:
1) They recommend more studies of behaviors and visual scanning patterns of nursing activities
2) They recommend that patient identifier information be displayed in prominent areas of paper and electronic documentation. They cite that often in electronic systems this information is in small print at the top of the screen.
3) Based on the results of these studies it may be possible to train nurses in visual scanning patterns such as looking for fewer pieces of info on many artifacts rather than lots of information on one artifact. The addition of technology such as barcode scanning may also assist in these activities although nurses are still expected to use visual scanning as validation.

The articles in this journal represent the amazing work for patient safety that can come from inter-professional collaborations especially from the medical/nursing professions and engineering and psychology. In thinking about the second study, I would also add a recommendation for reducing cognitive load. The pieces of information from the identifiers need to be small enough in size that the nurse can memorize them when performing visual scanning from one artifact to another. The average memory span is around 5-7 digits (have you ever played Simon? How many colors in a row can you remember especially after playing multiple times). If medical record numbers are being used as identifiers and they are longer than 5 digits or increase in length, they need to be displayed broken into smaller segments similar to the way a phone number is partitioned.

About this blog: You’ve heard of Leapfrog now there’s SafetyDog!

This blog will merge ideas from management, nursing, medicine and psychology (and many others) to offer a different view of patient safety. The author has a Masters in Industrial-Organizational Psychology, a graduate certificate in Error Science and Patient Safety and also a BSN in Nursing and has worked as an RN since 1985. All comments are welcome..you never know when one of your thoughts might save a life!

Patient Safety

IOM
Institute of Medicine..their 1999 report “To Err is human” started it all.

Leap Frog Group
The Consumer Reports for hospitals. Encouraging transparency and comparison of quality and safety.

ISMP
Institute for Safe Medication Practices. If you are looking for information on safe medication practices (and unsafe ones) they have great newsletters and other resources.

IHI
The Institute for Healthcare Improvement has an entire section on patient safety.

AHRQ
The Agency for Healthcare Research and Quality. Great site from the Department of Health and Human services. Contains research articles and safety guidelines and tools. The link is to Patient safety net

Healthcare Quarterly
Best practices and peer reviewed articles. Editor is a PhD from the University of North Carolina.